Stroke Protocol - FAST Assessment

CRITICAL

Rapid stroke assessment and management using the FAST protocol for early identification and treatment

Time is Brain!

Every minute, 1.9 million neurons die during a stroke. Rapid assessment and treatment are critical. Goal: Door-to-needle time <60 minutes for thrombolytics.

FAST Assessment Tool

Check each sign of stroke - positive findings indicate possible stroke

F - Face Drooping

Does one side of the face droop or is it numb? Ask the person to smile. Is the smile uneven?

Test: Ask patient to show teeth or smile

A - Arm Weakness

Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

Test: Raise both arms for 10 seconds with eyes closed

S - Speech Difficulty

Is speech slurred? Is the person unable to speak or hard to understand?

Test: Repeat "The sky is blue in Cincinnati"

T - Time to Call 911

If any of these signs are present, call 911 immediately. Note the time symptoms first appeared.

Immediate Actions

1.Activate stroke team/Call 911
2.Note exact time of symptom onset
3.Check blood glucose
4.Establish IV access
5.Perform 12-lead ECG
6.NPO status
7.Head of bed 30°

Critical Time Windows

0-3 hours

IV tPA eligible

3-4.5 hours

Extended tPA window (selected patients)

6-24 hours

Thrombectomy eligible (large vessel occlusion)

tPA Contraindications

• Symptom onset >4.5 hours
• Previous ICH
• Recent major surgery
• Active bleeding
• Platelets <100,000
• INR >1.7
• Blood glucose <50